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Many children younger than 5 years are exposed to multiple risks, including poverty, malnutrition, poor health, childhood stunting, language development and effect on cognitive function.1

The early childhood development is important because it has direct effect on their overall development and deeply affect their future physical, cognitive, emotional and social development. That is why understanding the need and improvement in very young children is so important to maximize their future well-being. 

Approximately 150 million of the world’s children under the age of 5 are stunted. Stunting is when a child is shorter than normal child in their age (height-for-age less than -2 standard deviations of the WHO Child Growth Standards median). There are many factors that contribute to childhood stunting including poor nutrition, repeated infection, and inadequate psychosocial stimulation.1

The understanding of the relationship is increased between the undernutrition, weak immune system, and stunting. The good nutrition is needed to support the immunity, healthy growth and development in children. The weak immune system makes the child more susceptible to infection and disease. In the present study, the incidence of infection was significantly lower among subjects who received the nutritional supplement.2


The body’s immune system is made up of two intrinsic systems, the innate and adaptive immunity.

o   The innate immunity is a general defense, immediate, nonspecific immune response and the first line of defense against foreign invaders. It consists of many natural barriers such as skin, mucosa lining cells, white blood cells (WBCs) called neutrophils and macrophages engulf and destroy foreign invaders and damaged cells, etc.

o   The adaptive immunity is a specific defense, and the second line of defense against foreign invaders.  It involves a complex, targeted response to a specific pathogen. Exposure to a pathogen stimulates the production of certain immune cells that mark the pathogen for destruction. The adaptive immunity consists of many kinds of naturally functional cell groups such as WBCs called T lymphocytes target and destroy infected cells and the other WBCs called B lymphocytes and plasma cells produce antibodies that target and destroy infected cells.

The key nutrients that supply for the function of immune system and for healthy growth:3,4,5

➢ Prebiotics & probiotics

• Prebiotics, molecules undigested by host, and are selectively fermented by “good” bacteria in the gut. Prebiotics are food and support growth of beneficial bacteria (probiotics) in the gut. Prebiotics used in human nutrition are FOS, GOS, Inulin, XOS, TOS, and SBOS….etc.

• Probiotics are live strains, similar to beneficial microbes naturally found in the gut, eg. Bifidobacterium & Lactobacillus. The beneficial effect of probiotics involves 4 mechanisms. (1) Produce antimicrobial substances toward pathogens. (2) Prevent colonization of pathogenic bacteria. (3) Immuno-modulate the host. (4) Inhibit the bacterial toxin production.

➢ Antioxidants (Vitamins C, E, Zinc, Selenium, Copper, Manganese). The antioxidants protect cell from oxidative damage and can stop damaging chain reaction caused by free radicals by neutralizing them.

➢ Vitamins A & D regulate immune cells and protect against infection. Vitamin D is required for regulation of calcium and phosphate for healthy bone mineralization of growing children.

➢ Triple-protein system (whey, soy, casein): 3 types of protein (whey, soy, casein) that provide a sustained supply of amino acids to support bone and muscle growth.

➢ Arginine: stimulate and activate the immune mediators. It also promotes the release of growth hormone and support the growth of bone. In a clinical study, children with stunting had lower serum concentration of arginine compared with non-stunted children.

➢ Vitamin K2: produced by bacteria and found in animal product and fermented food. Vitamin K2 is beneficial for strong bones formation. Without vitamin K2, decrease bone mass and increase risk of bone fractures. Vitamin K2 also supports bone building through a long good chain length. Vitamin K2 differs from Vitamin K1 that mainly works on a liver to support blood coagulation.

STAY STRONER GROW TALLERDid you know that……Kids who always fall sick during childhood are more likely to be shorter?

The better way to prevent development impairment in children is to feed them with the nutritious food, help them to be safe from suffering infections and diseases to attain the full potential growth and brain development.

Many studies reported when the immune status is improved in terms of fewer sick days, it results in weight gain or catch-up growth.7

Nutrition can help catch up growth and that is very important for helping stunting children to resume optimum growth. All children under 5 years of age can have the same height based on adequate nutrition and less disease environment. Nutrition plays crucial role as much as 80% to help children to reach their optimum growth and only 20% is impacted by genetic. Providing the best nutrition for early growth helps set the stage for normal development and for health and well-being throughout life.8

When the retarding growth is prolonged, the worse outcome of stunting is occurred and complete catch-up growth may not be achieved. The first 5 years is the window opportunity of life for height growth as early childhood growth plate open and easy for long bone growth, but in late puberty, the growth plate closes, and the growth velocity decreases to zero.9

The nutritional intervention by incorporating oral nutritional supplements (ONS) in the dietary counselling is more effective than the dietary counselling relying solely on foods.2

In fact, the dietary counselling using family foods has been shown to be more effective when combined with oral nutritional supplementation (ONS) of macro- and micronutrients in improving nutritional status in nutritionally at-risk children when compared with dietary counselling alone.9,10

References:1.      Sally et al. Child development in developing countries. Lancet 2007; 369:60-70

2.      Ghosh et al. Int J Med Res. 2018

3.      Markowiak and Slizewska 2017. Effects of probiotics, prebiotics and synbiotics on human health.


5.      Semba RD, Shardell M, Sakr Ashour FA, et al. Child Stunting is Associated with Low Circulating Essential Amino Acids. EBioMedicine. Apr 2016;6:246-252.


7.      Huynh et al. 2015, 2016

8.      WHO Multicenter Growth Reference Study Group 2006

9.      Alarcon et al, Clin Pediatr 2003

10.   Sheng X, Tong M, Zhao D, et al. (2014) Randomized controlled trial to compare growth parameters and nutrient adequacy in children with picky eating behaviors who received nutritional counseling with or without an oral nutritional supplement. Nutr Metab Insights 7, 85–94.

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